The impact of CREBRF rs373863828 Pacific-variant on infant body composition

In Māori and Pacific adults, the CREBRF rs373863828 minor (A) allele is associated with increased body mass index (BMI) but reduced incidence of type-2 and gestational diabetes mellitus. In this prospective cohort study of Māori and Pacific infants, nested within a nutritional intervention trial for pregnant women with obesity and without pregestational diabetes, we investigated whether the rs373863828 A allele is associated with differences in growth and body composition from birth to 12-18 months' corrected age. Infants with and without the variant allele were compared using generalised linear models adjusted for potential confounding by gestation length, sex, ethnicity and parity, and in a secondary analysis, additionally adjusted for gestational diabetes. Carriage of the rs373863828 A allele was not associated with altered growth and body composition from birth to 6 months. At 12-18 months, infants with the rs373863828 A allele had lower whole-body fat mass [FM 1.4 (0.7) vs. 1.7 (0.7) kg, aMD -0.4, 95% CI -0.7, 0.0, P = 0.05; FM index 2.2 (1.1) vs. 2.6 (1.0) kg/m2 aMD -0.6, 95% CI -1.2,0.0, P = 0.04]. However, this association was not significant after adjustment for gestational diabetes, suggesting that it may be mediated, at least in part, by the beneficial effect of CREBRF rs373863828 A allele on maternal glycemic status.

Health and Wellness Coaching for 5-Year Projected Cardiovascular Health: A Randomized Controlled Trial

Background and Objectives

Evidence of effective multifactorial lifestyle interventions for primary stroke prevention is lacking, despite the significant contribution of lifestyle to stroke burden. We aimed to determine the efficacy of health and wellness coaching (HWC) for primary stroke and cardiovascular disease (CVD) prevention in adults at a moderate-to-high CVD risk.

Methods

This was a parallel, 2-arm, open-label, single-blinded, phase III randomized controlled trial to determine the efficacy of HWC for primary stroke prevention in individuals 30 years and older with a 5-year CVD risk ≥10% as measured by 5-year absolute CVD risk (as measured by the PREDICT tool) at 9 months post-randomization. Eligible participants were those with a 5-year CVD risk ≥10%, with no history of stroke, transient ischemic attack, or myocardial infarction. The relative risk reduction (RRR) and odds ratios (OR) were evaluated separately in those at moderate (10%-14%) 5-year CVD risk and those at high risk (≥15%) at baseline. The Life's Simple 7 (LS7) score for lifestyle-related CVD risk, as the indicator of cardiovascular health, was a key secondary outcome.

Results

Of a total of 320 participants, 161 were randomized to the HWC group and 159 to the usual care (UC) group. HWC resulted in a statistically significant RRR of -10.9 (95% CI -21.0 to -0.9) in 5-year CVD risk in the higher CVD risk group but no change in the moderate risk group. An improvement in the total LS7 score was seen in the HWC group compared with the UC group (absolute difference = 0.485, 95% CI [0.073 to 0.897], p = 0.02). Improvement in blood pressure scores was statistically significantly greater in the HWC group than in the UC group for those at high risk of CVD (OR 2.28 [95% CI 1.12 to 4.63] and 1.55 [0.80 to 3.01], respectively). No statistically significant differences in mood scores, medication adherence, quality of life, and satisfaction with life scores over time or between groups were seen.

Discussion

Health and wellness coaching resulted in a significant RRR in the 5-year CVD risk compared with UC at 9 months post-randomization in patients with a high baseline CVD risk. There was no improvement in CVD risk in the moderate risk group; hence, this study did not meet the primary hypothesis. However, this treatment effect is clinically significant (number needed to treat was 43). The findings suggest that HWC has potential if further refined to improve lifestyle risk factors of stroke.

Pacific Islands Families Study: Household Food Security during Pregnancy and Secondary School Educational Achievement

Nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between nutrition in early life and academic achievement in adolescence. The birth cohort of the Pacific Islands Families (PIF) study was born in the year 2000. When their child was six weeks old, mothers were asked questions concerning food security over the past year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). In 2020, records of academic achievement from the National Certificate of Educational Achievement (NCEA) for 649 (317 female, 332 male) cohort members showed progressive achievement at levels 1, 2, and 3 of NCEA and allowed University Entrance (UE) to be assessed. The prevalence of food insecurity was not different for sex but high at 29% and 42% using the PIF and MOH definitions of food insecurity, respectively. More females (27%) than males (18%) achieved UE as their highest qualification, and more males (40%) than females (31%) achieved NCEA levels 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food-secure households and 17% from food-insecure households. Logistic regression demonstrated that the odds of achieving UE were 1.8-fold (95% CI 1.2, 2.6, p = 0.003) higher in females than males and, independently, 1.6-fold (95% CI 1.1, 2.5 p = 0.026) higher if the household was food secure. This work emphasises the importance of maternal and early-life food security for subsequent academic achievement and the well-being of future generations.

Vegetable-enriched bread: Pilot and feasibility study of measurement of changes in skin carotenoid concentrations by reflection spectroscopy as a biomarker of vegetable intake

Globally, bread is a staple food and thus a promising vehicle for the delivery of nutrients from vegetables including carotenoids. The aim of this pilot/feasibility, pre-post experimental study was to measure skin (Veggie Meter™) and plasma carotenoid concentrations 1 week before (week -1), immediately prior to (week 0), and after (week 2) 14 days of daily consumption of 200 g pumpkin- and sweetcorn-enriched bread (VB). At each measurement point, total vegetable and fruit intake and specific carotenoid-rich foods were assessed by questionnaire. Participants (n = 10, 8 males, 2 females) were aged between 19 and 39 years and weighed 90 ± 20 kg. Vegetable and fruit intake was low and less than one serving/day of foods containing carotenoids. Prior to the intervention, measures of carotenoid-containing foods and skin or plasma carotenoids were not different when measured a week apart. Consumption of the VB did not result in statistically significant changes in either the skin or plasma carotenoid measurements. Plasma carotenoid concentrations and the carotenoid reflection scores had a large and positive (r = .845, 95% CI 0.697, 0.924) association. The relationship between the number of servings of carotenoid-rich foods with the plasma carotenoid and carotenoid reflection scores was positive and of moderate strength. In conclusion, carotenoid status was not measurably changed with the consumption of 200 g VB each day for 2 weeks. Subjective carotenoid-rich food intake was positively associated with objective biomarkers of carotenoids. The Veggie meter™ has the potential to provide portable measurement of circulating carotenoids and be indicative of intake of carotenoid-rich foods.

Global food security, self-sufficiency and the cost of bread to Aotearoa

Nil.

External validation of a prediction model for estimating fat mass in children and adolescents in 19 countries: individual participant data meta-analysis

OBJECTIVE

To evaluate the performance of a UK based prediction model for estimating fat-free mass (and indirectly fat mass) in children and adolescents in non-UK settings.

DESIGN

Individual participant data meta-analysis.

SETTING

19 countries.

PARTICIPANTS

5693 children and adolescents (49.7% boys) aged 4 to 15 years with complete data on the predictors included in the UK based model (weight, height, age, sex, and ethnicity) and on the independently assessed outcome measure (fat-free mass determined by deuterium dilution assessment).

MAIN OUTCOME MEASURES

The outcome of the UK based prediction model was natural log transformed fat-free mass (lnFFM). Predictive performance statistics of R², calibration slope, calibration-in-the-large, and root mean square error were assessed in each of the 19 countries and then pooled through random effects meta-analysis. Calibration plots were also derived for each country, including flexible calibration curves.

RESULTS

The model showed good predictive ability in non-UK populations of children and adolescents, providing R² values of >75% in all countries and >90% in 11 of the 19 countries, and with good calibration (ie, agreement) of observed and predicted values. Root mean square error values (on fat-free mass scale) were <4 kg in 17 of the 19 settings. Pooled values (95% confidence intervals) of R², calibration slope, and calibration-in-the-large were 88.7% (85.9% to 91.4%), 0.98 (0.97 to 1.00), and 0.01 (-0.02 to 0.04), respectively. Heterogeneity was evident in the R² and calibration-in-the-large values across settings, but not in the calibration slope. Model performance did not vary markedly between boys and girls, age, ethnicity, and national income groups. To further improve the accuracy of the predictions, the model equation was recalibrated for the intercept in each setting so that country specific equations are available for future use.

CONCLUSION

The UK based prediction model, which is based on readily available measures, provides predictions of childhood fat-free mass, and hence fat mass, in a range of non-UK settings that explain a large proportion of the variability in observed fat-free mass, and exhibit good calibration performance, especially after recalibration of the intercept for each population. The model demonstrates good generalisability in both low-middle income and high income populations of healthy children and adolescents aged 4-15 years.

Bioactive Properties of Bread Formulated with Plant-based Functional Ingredients Before Consumption and Possible Links with Health Outcomes After Consumption- A Review

Bread is a commonly consumed staple and could be a viable medium to deliver plant-based ingredients that demonstrate health effects. This review brings together published evidence on the bioactive properties of bread formulated with plant-based ingredients. Health effects associated with the consumption of bread formulated with plant-based functional ingredients was also reviewed. Bioactive properties demonstrated by the functional ingredients fruits and vegetables, legumes, nuts and tea incorporated into bread include increased phenolic and polyphenolic content, increased antioxidant activity, and extension of bread shelf-life by impairment of lipid and protein oxidation. Acute health effects reported included appetite suppression, reduced diastolic blood pressure, improvements in glycaemia, insulinaemia and satiety effect. These metabolic effects are mainly short lived and not enough for a health claim. Longer term studies or comparison of those who consume and those who do not are needed. The incorporation of plant-based functional ingredients in bread could enhance the health-promoting effects of bread.

Associations of accelerometer measured school- and non-school based physical activity and sedentary time with body mass index: IPEN Adolescent study

Background

This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex.

Methods

Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11–19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models.

Results

Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found.

Conclusions

This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01324-x.

Effect of Cocoa Beverage and Dark Chocolate Consumption on Blood Pressure in Those with Normal and Elevated Blood Pressure: A Systematic Review and Meta-Analysis

Cocoa is a major dietary source of polyphenols, including flavanols, which have been associated with reduced blood pressure (BP). While earlier systematic reviews and meta-analyses have shown significant effects of cocoa consumption on systolic BP, limitations include small sample sizes and study heterogeneity. Questions regarding food matrix and dose of polyphenols, flavanols, or epicatechins remain. This systematic review and meta-analysis aimed to investigate the effects of ≥2 weeks of cocoa consumption as a beverage or dark chocolate in those with normal or elevated (< or ≥130 mmHg) systolic BP measured in the fasted state or over 24-h. A systematic search conducted on PubMed and Cochrane Library databases up to 26 February 2022 yielded 31 suitable articles. Independent of baseline BP, cocoa consumption for ≥2 weeks was associated with reductions in systolic and diastolic BP (p < 0.05, all). Compared with cocoa, chocolate lowered the weighted mean of resting systolic BP (−3.94 mmHg, 95% CI [−5.71, −2.18]) more than cocoa beverage (−1.54 mmHg, 95% CI [−3.08, 0.01]). When the daily dose of flavanols was ≥900 mg or of epicatechin ≥100 mg, the effect was greater. Future, adequately powered studies are required to determine the optimal dose for a clinically significant effect.

Tamarillo Polyphenols Encapsulated-Cubosome: Formation, Characterization, Stability during Digestion and Application in Yoghurt

Tamarillo extract is a good source of phenolic and anthocyanin compounds which are well-known for beneficial antioxidant activity, but their bioactivity maybe lost during digestion. In this study, promising prospects of tamarillo polyphenols encapsulated in cubosome nanoparticles prepared via a top-down method were explored. The prepared nanocarriers were examined for their morphology, entrapment efficiency, particle size and stability during in vitro digestion as well as potential fortification of yoghurt. Tamarillo polyphenol-loaded cubosomes showed cubic shape with a mean particle size of 322.4 ± 7.27 nm and the entrapment efficiency for most polyphenols was over 50%. The encapsulated polyphenols showed high stability during the gastric phase of in vitro digestion and were almost completely, but slowly released in the intestinal phase. Addition of encapsulated tamarillo polyphenols to yoghurt (5, 10 and 15 wt% through pre- and post-fermentation) improved the physicochemical and potential nutritional properties (polyphenols concentration, TPC) as well as antioxidant activity. The encapsulation of tamarillo polyphenols protected against pH changes and enzymatic digestion and facilitated a targeted delivery and slow release of the encapsulated compounds to the intestine. Overall, the cubosomal delivery system demonstrated the potential for encapsulation of polyphenols from tamarillo for value-added food product development with yoghurt as the vehicle.

Effect of In Vitro Gastrointestinal Digestion on Amino Acids, Polyphenols and Antioxidant Capacity of Tamarillo Yoghurts

Laird’s Large tamarillo powder is high in protein (10%) essential amino acids (EAAs), gamma-aminobutyric acid (GABA) and polyphenols (0.6% phenolics plus anthocyanins) and fibre 25%. This study aimed to investigate, using a standardized static in vitro digestion model, the stability of amino acids and antioxidant capacity of polyphenols in yoghurt fortified with 5, 10 and 15% tamarillo powder either before (PRE) or after (POS) fermentation. Compared to plain yoghurt, the fruit polyphenols (rutinosides and glycosides) were retained and substantial increases in FEAAs (free essential amino acids), total phenolic content (TPC) and antioxidant activity were observed particularly at the end of intestinal phase of digestion. Together with SDS-PAGE results, peptides and proteins in tamarillo yoghurts were more easily digested and therefore may be better absorbed in the small intestine compared to the control. TPC and antioxidant activity of fortified yoghurts increased significantly after in vitro digestion. Relatively high bioaccessibilty of chlorogenic acid and kaempferol-3-rutinoside in digested PRE samples was observed. The results suggest that the yoghurt matrix might protect some compounds from degradation, increasing bioaccessibility and in the small intestine allow increased absorption and utilization possible. Fortification would deliver intact polyphenols and fibre to the large intestine and improve gut health. Further research of acceptability, shelf life, and then trials for health effects should be implemented.

Glycaemic and Appetite Suppression Effect of a Vegetable-Enriched Bread

Bread, a frequently consumed food, is an ideal vehicle for addition of ingredients that increase nutrient density and add health benefits. This experimental cross-over study sought to test the effect of a vegetable-enriched bread (VB) in comparison to commercial white bread (WB) and wheatmeal bread (WMB) on serum glucose, insulin response and subjective appetite suppression. On three separate occasions, 10 participants (23 ± 7 years) visited the laboratory and consumed after an overnight fast, in random order, a 75 g serve of WB, WMB or VB. Venous blood samples drawn twice before (0 min) and at 15, 30, 45, 60, 90 and 120 min after consumption of the bread were analysed for glucose and insulin. Participants rated their subjective feelings of hunger, fullness, satisfaction and desire to eat on a 150 mm Likert scale. The mean glucose iAUC over 120 min was not different among the breads. The mean insulin iAUC for the VB was significantly lower than the WB and WMB; difference VB and WB 12,415 pmol/L*minutes (95% CI 1918, 22,912 pmol/L*minutes, p = 0.025) and difference VB and WMB 13,800 pmol/L*minutes (95% CI 1623, 25,976 pmol/L*minutes p = 0.031). The VB was associated with a higher fullness feeling in the participants over the 120-min period. The consumption of VB was associated with less insulin release and higher satiety over 120 min which may be related to the higher fibre content and texture of VB. The role of vegetable and fruit fibres such as pectin in bread and insulin response should also be further explored.

How to promote experiential knowledge in public health: a new training for French practitioners

Background

In France, Health Promotion (HP) practitioners lack tools to document and share how their interventions work. To bridge this gap, a national committee of HP practitioners, policymakers and researchers designed a new method to Capitalize, i.e. collect, analyse and share through summaries, Experiential Knowledge (EK) in HP (CEKHP). A training program was created in 2020 to disseminate CEKHP process and tools.

Objectives

After undertaking CEKHP training, participants shall be able to design and promote their own CEKHP projects. Each training session (30 hours in total) alternates short theoretical courses, workshops and the completion of a capitalization in real professional situation. Expert members of the committee designed the training following a skills-based approach. They sequentially identified: targeted occupations, competencies, how to assess them, then designed the curriculum. Two core competencies are built up: 1/ valuing EKHP, through advocacy and project design; 2/ guiding with CEKHP the collection of EK on HP interventions and its circulation. The training covers 11 competencies of the WHO-ASPHER Competency Framework. In 2021, 2 sessions were organised to test its relevance in an adult learning situation (group of 12 professionals) and in a master's degree program (group of 9 students).

Results

The learning-by-doing method was fruitful: all participants, in both settings, completed their capitalization. A few trainees chose to document interventions or organisational adaptations linked with the Covid-19 crisis, for which EK is especially valuable. They also reported added benefits: self-reinforcement, rare in-depth exchanges with fellow HP practitioners, etc.

Conclusions

A training strategy combining adult learning and student teaching can be effective to disseminate CEKHP. All trainees are now invited to join a community of practice, which will provide them with additional tools and network resources, through a national EKHP resource center.

Key messages

A training program focused on building up experiential knowledge capacities is a lever for disseminating experiential knowledge in France, among both current and future health promotion practitioners. The real-life case study, i.e. the completion under supervision of the capitalization of a health promotion intervention, is an essential component of the new experiential knowledge training program.

Documenting experiential knowledge to enhance breast and cervical cancers screening uptake in France

Issue

Improving uptake of Cancer Screening programs (CS) remains a public health priority in France, as stated in the latest national cancer control strategy. The French Society for Public Health designed in 2020 a project to document Interventions Promoting CS Participation (IPCSP) for vulnerable groups, for both breast and cervical cancers. This project provides experiential and practical evidence built up from IPCSP and offers relevant insights for the new strategy.

Methods

The project aims at capitalizing, i.e. collecting, documenting and circulating, experiential knowledge from practitioners who implement IPCSP locally (health professionals, social workers, grassroots organizations, etc.). The project consists in 3 main steps: 1/identify promising IPCSP through a nationwide call for applications; 2/ document the key mechanisms impacting how IPCSP unfold (context, partnerships, barriers and levers, ethics), 3/ publish a summary for each IPCSP, available online. The goal is to build up original knowledge from field actions, documenting how IPCSP tackle several factors that can hinder uptake, in various contexts.

Results

20 IPCSP were selected. IPCSP targets included: women of low-income neighborhoods, allophone women, inhabitants of healthcare deserts, handicapped persons, etc. Most IPCSP (16 out of 20) featured reaching out strategies, such as: peer education, on-site screenings, etc. All promoted informed choice. A cross-case analysis of IPCSP highlighted key, recurring implementation levers. One is co-constructing IPCSP throughout within local, multi-professional, long-standing partnerships, in which partners bring complementary skills: medical expertise, proximity with target populations, project management skills, community engagement skills, etc.

Lessons

20 detailed summaries will offer concrete data on how to put insights to enhance CS uptake into action. Other stakeholders and policymakers alike can benefit from experiential knowledge built up from IPCSP.

Key messages

Documenting interventions promoting uptake of breast and cervical cancer screening programs and detailing how they work is crucial to building knowledge and to helping enhance participation for all. Partnerships can provide effective, population-specific and context-specific levers to promote uptake of cancer screening programs in France. Co-constructing the intervention throughout is key.

Volatile Components and Preliminary Antibacterial Activity of Tamarillo (Solanum betaceum Cav.)

Tamarillo is a nutrient-dense fruit with a unique aroma from its volatile compounds (VCs). In this study, we aimed to compare the volatile profiles: (i) of fresh and freeze-dried tamarillo; (ii) detected using Thermal Desorption–Gas Chromatography–Mass Spectrometry (TD–GC–MS) and Solid-Phase MicroExtraction–Gas Chromatography-Mass Spectrometry (SPME–GC–MS); (iii) of freeze-dried pulp and peel of New Zealand grown tamarillo. The possible antibacterial activity of freeze-dried tamarillo extracts was also investigated. We show that freeze-drying maintained most of the VCs, with some being more concentrated with the loss of water. The most abundant VC in both fresh and freeze-dried tamarillo was hexanoic acid methyl ester for pulp (30% and 37%, respectively), and (E)-3-Hexen-1-ol for peel (36% and 29%, respectively). With the use of TD–GC–MS, 82 VCs were detected for the first time, when compared to SPME–GC–MS. Methional was the main contributor to the overall aroma in both peel (15.4 ± 4.2 μg/g DW) and pulp (118 ± 8.1 μg/g DW). Compared to water as the control, tamarillo extracts prepared by water and methanol extraction showed significant antibacterial activity against E. coli, P. aeruginosa, and S. aureus with zone of inhibition of at least 13.5 mm. These results suggest that freeze-dried tamarillo has a potential for use as a natural preservative to enhance aroma and shelf life of food products.

Swallowing and Liking of Vegetable-Enriched Bread Compared With Commercial Breads as Evaluated by Older Adults

Characteristics of food that influence liking and ease-of-chewing and swallowing are not well-understood. Reformulation of bread to improve nutrient density may improve liking, ease-of-chewing and swallowing which could improve dietary intake particularly with aging. The study aimed to compare objectively and subjectively four breads of increasing nutrient density: $1 white (WB) and wheatmeal (WMB) commercial breads and two in-house formulations of vegetable-enriched breads (VB75 or VB100) which incorporated drum-dried pumpkin and sweet corn flours for physical, sensory and ease-of-chewing and swallowing properties. Each bread underwent instrumental texture analysis. The commercial and vegetable-enriched breads were not different by hardness or springiness but the vegetable breads were up to 25% less cohesive, less gummy and less chewy than the commercial breads. Questionnaires and Likert scale (150 mm) responses were completed by 50 physically active volunteers aged 50+ years. Overall liking of the VB75 and VB100 was rated 40% higher than the white and wheatmeal breads. Vegetable-enriched breads were rated as almost 50% easier to chew (mean ± SD; WB 70.53 ± 39.46 mm, WMB 77.68 ± 33.13 mm, VB75 104.78 ± 30.69 mm, VB100 107.58 ± 24.90 mm) and swallow (WB 70.29 ± 37.98 mm, WMB 77.53 ± 34.88 mm, VB75 104.63 ± 28.25 mm, VB100 104.90 ± 25.54 mm). Vegetable-enriched breads compared to white and wheatmeal breads were instrumentally and subjectively less gummy, cohesive and chewy than commercial breads and have the potential to both improve nutrition and "ease of swallowing" in older people. New areas of research should explore other underutilized vegetables for bread enrichment and their ability to aid swallowing and improve nutrition status.

Cardiorespiratory effects of project energize: a whole-of region primary school nutrition and physical activity programme in New Zealand in 2011 and 2015

Background

Since 2004, Sport Waikato has delivered Project Energize, a through-school nutrition and physical activity program to primary schools in the Waikato. As part of the program’s continued assessment and quality control, the programme was evaluated in 2011 and 2015. This paper’s aim was to compare the cardiorespiratory fitness (time to run 550 m (T₅₅₀)) levels of children participating in Project Energize in 2011 and 2015.

Methods

In the 2011 evaluation of Project Energize, gender specific- T₅₅₀-for-age Z scores (T₅₅₀AZ) were derived from the T₅₅₀ of 4832 Waikato children (2527 girls; 2305 boys; 36% Māori) aged between 6 and 12 years. In 2015, T₅₅₀ was measured for 4798 (2361 girls; 2437 boys; 32% Māori) children, representative of age, gender and school socioeconomic status (SES). The T₅₅₀AZ for every child in the 2015 study and 2011 evaluation were derived and differences in T₅₅₀ between 2015 and 2011 by gender, SES and age were determined using independent t-tests. Multiple regression analysis predicted T550 Z score and run time, using year of measurement, gender, ethnicity, age and school SES.

Results

With and without adjustment, children in 2015 ran 550 m faster than in 2011 (adjusted Z score 0.06, time 11 s). Specifically, girls ran at a similar speed in 2015 as 2011 but boys were faster than in 2011 (Z score comparison P < 0.001, mean difference 0.18 95%CI 0.12, 0.25). Regression analysis showed time taken to run 550 m was 11 s less in 2015 compared with 2011. Boys ran it 13 s faster than girls (Z score 0.07) and for each 1 year age increase, children were 8 s slower (Z score 0.006). For each 10% decrease in SES, children were 3 s slower (Z score 0.004) and Māori children were 5 s slower than Non-Māori children (Z score 0.15).

Conclusions

The findings from this study support the continuation of the delivery of Project Energize in the Waikato region of New Zealand, as cardiorespiratory fitness scores in 2015, compared to 2011, were improved, particularly for lower SES schools and for Māori children. Ethnically diverse populations, schools with higher deprivation and girls, continue to warrant further attention to help achieve equity.

Valuing experiential knowledge in health promotion: a new method to build up knowledge in France

Issue

Effectiveness analyses of health promotion (HP) interventions (HPI) abound nowadays in France, but few research details how HPI work, nor explains how practitioners can translate conclusive evidence from the literature into action. Furthermore, large amounts of experiential knowledge remain untapped and undervalued. To close these gaps, a national multidisciplinary committee, comprising public officials, academics and practitioners, has worked since 2016 at designing a new method to build up knowledge in HP.

CEKHP

The method aims at Capitalizing, collecting and circulating Experiential Knowledge in HP (CEKHP).

Committee members first investigated methods used in other countries to synthesize and share practical evidence, then drafted and experimented CEKHP in 11 different settings to test its relevance and applicability.

Results

Key components of CEKHP are: 1/CEKHP consists in in-depth semi-structured interviews and offers a guideline template adjustable for various contexts and multiple public health issues (behaviors, environments, etc.); 2/a trained outsider, mastering 7 core competencies, must conduct CEKHP; 3/CEKHP includes a framework for reporting key mechanisms that influence HPI outcomes. Detailed mechanisms include: context, partnerships, key steps, barriers and levers, ethics, theoretical foundations (intervention models, evidence-based literature, etc.), transferability. A guidebook and a toolkit are published in 2020. CEKHP successfully disseminates within the French HP community. It is currently used as the main data collection tool in a research project investigating health promoting sports clubs (PROCeSS) and in a practice-focused project documenting tobacco prevention (DCAP).

Lessons

Practitioners benefit from access to knowledge on how HPI work. CEKHP offers new tools to value and disseminate experiential knowledge. Given that policymakers increasingly prioritize funding in France on documented HPI, providing such tools and training is crucial.

Key messages

CEKHP offers a new method in the French context that has proven fruitful in various settings, for various public health issues, and can be useful to practitioners and researchers alike. Building up experiential knowledge with and for practitioners can be effective at both documenting practices and helping them gain new skills and better understanding of their interventions.

Rare musculoskeletal diseases in adults: a research priority setting partnership with the James Lind Alliance

BACKGROUND

Osteogenesis imperfecta, fibrous dysplasia/McCune-Albright syndrome and X-linked hypophosphatemia are three rare musculoskeletal diseases characterised by bone deformities, frequent fractures and pain. Little high-quality research exists on appropriate treatment and long-term management of these conditions in adults. This is further worsened by limited research funding in rare diseases and a general mismatch between the existing research priorities and those of the patients. This partnership adopted the James Lind Alliance approach to identify the top 10 research priorities for rare musculoskeletal diseases in adults through joint patient, carer and healthcare professional collaboration.

RESULTS

The initial survey for question collection recruited 198 respondents, submitting a total of 988 questions. 77% of the respondents were patients with a rare musculoskeletal disease. Following out-of-scope question exclusion, repeating query grouping and scientific literature check for answers, 39 questions on treatment and long-term management remained. In the second public survey, 220 respondents, of whom 85% were patients with a rare musculoskeletal disease, their carers, relatives or friends, prioritised these uncertainties, which allowed selection of the top 25. In the last stage, patients, carers and healthcare professionals gathered for a priority setting workshop to reach a consensus on the final top 10 research priorities. These focus on the uncertainties surrounding appropriate treatment and holistic long-term disease management, highlighting several aspects indirect to abnormal bone metabolism, such as extra-skeletal symptoms, psychological care of both patients and their families and disease course through ageing.

CONCLUSIONS

This James Lind Alliance priority setting partnership is the first to investigate rare bone diseases. The priorities identified here were developed jointly by patients, carers and healthcare professionals. We encourage researchers, funding bodies and other stakeholders to use these priorities in guiding future research for those affected by rare musculoskeletal disorders.

Outcomes of a church-based lifestyle intervention among Australian Samoans in Sydney - Le Taeao Afua diabetes prevention program

AIMS

To evaluate the effectiveness of a culturally adapted, church-based lifestyle intervention among Australian Samoans living in Sydney.

METHODS

This was a prospective, pre-post study of a church-wide education and support programme delivered by Community Coach Facilitators and Peer Support Facilitators to prevent, and promote self-management of, Type 2 diabetes. Participants completed questionnaires, anthropometric and HbA1c measurements before and 3-8 months after the intervention. The primary outcome was HbA1c.

RESULTS

Overall, 68/107(63.5%) participants completed both before and after intervention data collection (mean age 48.9 ± 14.2 years; 57.2% female). HbA1c dropped significantly between baseline and follow-up among participants with known diabetes (8.1 ± 2.4% (65 mmol/mol) vs 7.4 ± 1.8% (57 mmol/mol); p = 0.040) and non-significantly among participants with newly diagnosed diabetes (8.0 ± 2.1% (64 mmol/mol) vs 7.1 ± 2.3 (54 mmol/mol); p = 0.131). Participants with no diabetes increased their weekly moderate and vigorous physical activity (316.1 ± 291.6mins vs 562.4 ± 486.6mins; p = 0.007) and their diabetes knowledge also improved post-intervention (42.0 ± 13.5% to 61.3 ± 20.2%; p < 0.001). There were no significant reductions in blood pressure, BMI or waist circumference at follow-up.

CONCLUSIONS

A structured, church-based, culturally tailored lifestyle intervention showed a number of improvements in diabetes risk among Samoans in Sydney. The intervention however, requires a more rigorous testing in a larger randomised controlled trial over a longer time period.

Food exports and imports of New Zealand in relation to the food-based dietary guidelines

BACKGROUND/OBJECTIVES

It has not been reported that previously how much food New Zealand (NZ), population 4.9 million (M), exports and imports in terms of how many people this food would feed if the food-based dietary guidelines (FBDG) were followed. In New Zealand, 40% of adults and 20% of children live in a household with severe to moderate food insecurity.

METHODS

Official data for foods and beverages exported and imported between 2016 and 2018 was obtained from Statistics New Zealand. Harmonised food classifications were matched to either a food group or as discretionary foods or ingredients. Standard serving sizes in grams and number of servings/day from each food group viz; vegetables, 5 servings/day; fruit, 2 servings/day; grains 6 servings/day; meat and protein foods 2.5 servings/day: and dairy 2.5 servings/day were used to determine how many people would be fed each year with the food traded. Together these servings should meet a daily energy intake in the order of 8 MJ. The trade of discretionary foods and ingredients, alcoholic beverages, butter and sugar was also examined.

RESULTS

According to the guidelines the quantity of food exported each year by NZ had enough numbers of servings to feed 39 M dairy, 11.5 M meat, seafood and other protein, 2 M vegetables and 10 M fruit day/year. Imports were dominated by grains, enough to feed 9 M six servings a day/year. Total food energy exported and imported was enough to meet the energy requirements for 20 M (30% from butter) and 10 M (27% from sugar), respectively.

CONCLUSIONS

The high prevalence of food insecurity and obesity in NZ could be partially attributed to the disconnect between the quantity, nutritional quality and diversity of foods imported and exported.

Availability and price of healthier food choices and association with obesity prevalence in New Zealand Māori

BACKGROUND AND OBJECTIVES

Examine availability and price of healthier foods-vs-regular counterparts and their association with obesity.

METHODS AND STUDY DESIGN

A cross-sectional survey of weight and height among Māori in 2 urban and 96 rural areas in the Waikato/Lakes Districts-NZ (year 2004-06) was undertaken. Concurrently, availability of 11 'healthier' food in fast-food-outlets was examined by location (urban vs rural) and median income (high-low). In supermarkets, five-specific 'regular' foods were scored against 'healthier' counterparts (white-vs-wholemeal bread, with-skin-vs-skinless chicken, regular-vs-trim meat, standard-vs-trim milk, sugarsweetened- beverages vs-water) for in-store availability and price according to the Nutrition Environment Measures Survey.

RESULTS

Overall, 3,817 Māori (BMI: women: 32.9±7.8 kg/m2; men: 33.1±6.7 kg/m2) were included with 451 food-outlets in two urban-clusters and 698 food-outlets in 96 rural-clusters. Fast-foods: The availability of healthier food choices was higher for 8/11 items in rural and low-income areas than urban and high-income areas. Multivariate analysis considered location and income as cofactors. No association between number of fast-food-outlets/cluster and healthier foods/cluster with obesity prevalence (General/Māori BMI cutoffs) was observed. Supermarkets: Water was cheaper than sugar-sweetened-beverages and negatively associated with obesity prevalence (General r=-0.53, p=0.03; Māori r=-0.53, p=0.03); high availability scores for trim milk compared to standard milk correlated with higher obesity prevalence (General r=0.49, p=0.04; Māori r=0.57, p=0.01).

CONCLUSIONS

Bottled water vs sugar-sweetened-beverages prices were inversely associated with obesity. This supports the argument to regulate the availability and price of sugar-sweetened-beverages in NZ. The positive association of the availability of trim milk with the prevalence of obesity warrants investigation into individual's dietary and food-purchase behaviour.

The Importance of Pedestrian Network Connectivity for Adolescent Health: A Cross-sectional Examination of Associations between Neighbourhood Built Environments and Metabolic Health in the Pacific Islands Families Birth Cohort Study

The research aim was to investigate associations between objectively-assessed built environment attributes and metabolic risk in adolescents of Pacific Islands ethnicity, and to consider the possible mediating effect of physical activity and sedentary time. Youth (n = 204) undertook a suite of physical assessments including body composition, blood sampling, and blood pressure measurements, and seven day accelerometry. Objective measures of the neighbourhood built environment were generated around individual addresses. Logistic regression and linear modelling were used to assess associations between environment measures and metabolic health, accounting for physical activity behaviours. Higher pedestrian connectivity was associated with an increase in the chance of having any International Diabetes Federation metabolic risk factors for males only. Pedestrian connectivity was related to fat free mass in males in unadjusted analyses only. This study provides evidence for the importance of pedestrian network connectivity for health in adolescent males. Future research is required to expand the limited evidence in neighbourhood environments and adolescent metabolic health.

Vegetables: New Zealand Children Are Not Eating Enough

We know that eating a variety of vegetables every day is associated with favorable health across the lifecourse. Internationally, food-based dietary guidelines encourage the consumption of a variety of vegetables and fruit but globally,people are not eating enough vegetables to meet the three-or-more-a-day guideline. Vegetables are good sources of vitamins and minerals, fiber, and many bioactive compounds that promote health and provide energy. They also help reduce hidden hunger (micronutrient deficiencies) and support the healthy growth and development of children. New Zealand is a world leader in the production of diverse nutrients and foods yet poverty and other environmental barriers mean only one in two children eats three-or-more servings of vegetables a day. Price and availability are limiting factors. The proliferation of community, school and home vegetable gardens and vegetable cooperatives may improve access. On a macro level, upstream policies such as a "living wage," affordable housing, and land-use planning are required. International dietary solutions include an agricultural shift to intensified horticulture with a focus on vegetables. The consumption of more plant-based foods including vegetables would reduce green-house gases, reduce land clearing, and help prevent diet-related disease if consumed daily across the lifecourse.

Application of Stable Isotopic Techniques in the Prevention of Degenerative Diseases like Obesity and NIDDM in Developing Societies

Economic development in developing societies characterized by idustrialization, urbanization, and globalization has seen the emergence of an epidemic of diet- and life-style-related chronic degenerative diseases. A research project was initiated under the aegis of the International Atomic Energy Agency (IAEA), Vienna, Austria under its Coordinated Research Programme (CRP) to promote the use of stable isotopic techniques to document the extent of the problem and to understand the determinants of this epidemic. The principal objectives of this CRP involving countries both in the North and the South are to define the magnitude of the problem of obesity and non-insulin dependant diabetes mellitus (NIDDM) in developing countries, to identify the vulnerable groups at increased risk, and to attempt to describe the metabolic and physiological mechanisms underlying this phenomenon. These comparative international studies of obesity and NIDDM are looking at the effects of childhood malnutrition (Brazil) and socioeconomic differentials (Mexico) on adult risk factors; the composition of the daily diet on obesity (Chile); levels of patterns of physical activity of older adults (China) as well as their influence on weight gain and obesity (Cuba, Nigeria); the impact of body composition and energy expenditure on the evolution frank diabetes from impaired glucose tolerance (Jamaica), and of body compositional changes and the role of inflammatory cytokines on impaired glucose tolerance (India). The last study conducted in New Zealand was aimed at comparing the energy expenditures of Maori (Pacific Island) with New Zealanders of European descent.

Timing of Atlantic salmon Salmo salar smolt migration predicts successful passage through a reservoir

Around 30% of Atlantic salmon Salmo salar smolts successfully survived passage through Loch Meig, a reservoir in the north of Scotland, en route to the sea. However, this survival rate was in turn dependent on the timing of migration, with the earliest migrants in the spring having the best chance of survival. This could have implication for fisheries management, since the estimation of smolt downstream survival may be influenced by which time period of the smolt run is analysed.

Vitamin B12 Status of Various Ethnic Groups Living in New Zealand: An Analysis of the Adult Nutrition Survey 2008/2009

Vitamin B12 deficiency leads to serious health problems, whilst sub-optimal status is associated with raised biochemical markers of disease risk. Identifying at-risk groups could benefit both individuals and public health. Dietary data were sourced from the New Zealand Adult Nutrition Survey 2008/2009, involving a nationally representative sample of 4721 participants. Ethnic groupings were by regional origin: Māori and Pacific Islands, New Zealand European, East and South-East Asian, and South Asian. Diets were assessed using 24-h recalls and from responses to a questionnaire. Blood samples were obtained from a subset (n = 3348). The mean (95% CI) vitamin B12 intake of the Māori and Pacific Islands group was 5.1 (4.7, 5.5) µg/day, New Zealand Europeans 4.1 (3.8, 4.3) µg/day, East and South-East Asians 4.5 (3.7, 5.3) µg/day, and South Asians 3.0 (2.5, 3.6) µg/day. Overall, 20.1% of the sample had vitamin B12 inadequacy (<221 pmol/L). South Asians had the lowest vitamin B12 concentration at 282 (251, 312) pmol/L, whilst Māori/Pacific and East/South-East Asians had the highest, at 426 (386, 466) and 425 (412, 437) pmol/L, respectively. The main dietary determinant of serum vitamin B12 concentration was whether or not people ate red meat, with a regression coefficient of 27.0 (95% CI: 6.6, 47.5). It would be helpful for health agencies to be aware of the potential for compromised vitamin B12 status in South Asian communities.

Primary prevention of stroke and cardiovascular disease in the community (PREVENTS): Methodology of a health wellness coaching intervention to reduce stroke and cardiovascular disease risk, a randomized clinical trial

Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10-15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease.

Face-to-face versus telephone delivery of the Green Prescription for Māori and New Zealand Europeans with type-2 diabetes mellitus: influence on participation and health outcomes

AIM

In Aotearoa/New Zealand, the proportion of Māori who participate in the national Green Prescription lifestyle programme is lower than for New Zealand Europeans. We compared the uptake and effectiveness of two modes of Green Prescription delivery: face-to-face and telephone among both Māori and New Zealand Europeans.

METHOD

Sixty-eight Māori and 70 New Zealand Europeans with type-2 diabetes participated in this six-month randomised trial of the two modes of delivery. Recruitment integrated an explicitly Māori culturally sensitive approach. All participants received lifestyle intervention. Anthropometry, blood lipids and glycated haemoglobin were measured before and after the intervention.

RESULTS

The face-to-face approach (first meeting) yielded 100% uptake into the programme among both Māori and New Zealand Europeans. At six months there were overall reductions in weight (1.8; [95 CI%, 0.6, 2.9kg]), waist circumference (3.7 [2.6, 4.8cm]), and total cholesterol (0.6 [0.3, 0.9mmol/l]) and glycated haemoglobin (3.1 [-0.2, 6.7mmol/mol]). There were no significant differences by mode of delivery, ethnicity or gender.

CONCLUSION

The Green Prescription programme resulted in small but clinically favourable improvements in health outcomes for type-2 diabetes patients, regardless of the mode of delivery for both Māori and New Zealand Europeans.

The RUDY study: using digital technologies to enable a research partnership

Patients have extensive experience of their disease that can enhance the design and execution of research leading to significant innovations and efficiencies in the research process. The research community on the whole have been slow to adopt practices that enable patients to become active partners in research. Digital technologies are providing the means to do this more easily and so are increasingly being used to interact with patients and involve them in the design and execution of research. The RUDY (Rare UK Diseases of bone, joints and blood vessels) study's pioneering approach applies a custom-developed electronic platform where patients can contribute information over time about their disease experience, lifestyle and clinical history. This is combined with a state-of-the-art Dynamic Consent model and a commitment to patient-driven research, to further our understanding of rare diseases. This paper describes the RUDY study and the benefits that have been gained from adopting this partnership approach to research.

Effect of Cold Storage and Reheating of Parboiled Rice on Postprandial Glycaemic Response, Satiety, Palatability and Chewed Particle Size Distribution

Background: Globally, hot cooked refined rice is consumed in large quantities and is a major contributor to dietary glycaemic load. This study aimed to compare the glycaemic potency of hot- and cold-stored parboiled rice to widely available medium-grain white rice. Method: Twenty-eight healthy volunteers participated in a three-treatment experiment where postprandial blood glucose was measured over 120 min after consumption of 140 g of rice. The three rice samples were freshly cooked medium-grain white rice, freshly cooked parboiled rice, and parboiled rice stored overnight at 4 °C. All rice was served warm at 65 °C. Chewing time was recorded. Results: incremental area under the curve (iAUC) of the control rice, freshly cooked medium-grain white rice, was the highest: 1.7-fold higher (1.2, 2.6) than reheated parboiled rice (p < 0.001) and 1.5-fold higher (1.0, 2.2) than freshly cooked parboiled rice (p = 0.001). No significant difference in postprandial glycaemic response was observed between freshly cooked and reheated parboiled rice samples (p = 0.445). Chewing time for 10 g cold-stored parboiled rice was 6 s (25%) longer and was considered more palatable, visually appealing and better tasting than freshly cooked medium-grain (all p < 0.05). Conclusions: For regular consumers of rice, reheating cooked rice after cold storage would lower the dietary glycaemic load and, in the long term, may reduce the risk for type 2 and gestational diabetes. More trials are needed to identify the significance.

Under 5 Energize: Tracking Progress of a Preschool Nutrition and Physical Activity Programme with Regional Measures of Body Size and Dental Health at Age of Four Years

To reduce weight gain and encourage healthy eating including reduced sugar intake, Under 5 Energize (U5E) was introduced to 121 early-childhood-centres in the Waikato region of New Zealand in July 2013. Using anonymized data collected from January 2013 to September 2016 through free physical assessments of all 4-year-olds provided by the NZ Ministry of Health, the prevalence of obesity and dental decay children measured in the Waikato region was examined. Data were divided into four periods representing pre-implementation and 3 years of gradual implementation. Obesity was defined according to International Obesity Task Force criteria. Of 18,774 Waikato children included in the analysis, 32% were indigenous Māori, and 32% attended an U5E centre. Pre-implementation prevalences of obesity (4%) and visible dental decay (11%) of children attending and not-attending U5E centres were not different. While obesity prevalence did not change significantly over time, prevalence of dental decay decreased among children at U5E (trend p = 0.003) but not non-U5E (trend p = 0.14) centres, such that prevalences were significantly different between children at U5E vs. non-U5E centres at Year 3 (p = 0.02). The U5E intervention is a small but arguably effective part of the wider system approach that is required to improve children’s future health.

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

Accelerometer data treatment for adolescents: Fitting a piece of the puzzle

This study aimed to assess the differences in participant retention and associations between physical activity and key variables when a range of accelerometer data inclusion criteria are employed. Data were drawn from 204 adolescents of Pacific Island heritage (survey, body composition, 7-day accelerometry) and their parents (date of birth, socioeconomic status) between October 2014 and February 2016 in Auckland, New Zealand. Data wear time criteria for inclusion were as follows: A) > = 10 h/weekday or > = 8 h weekend day, > = 5 days (at least one weekend day); B) > = 10 h/weekday or > = 8 h weekend day, > = 4 days; C) > = 7 h/day, > = 3 days; D) > = 10 h/day, > = 1 day. Overall, 49%, 62%, 88%, and 96% of participants met the criteria, respectively. Adjusted odds of meeting each criterion were examined using a multivariable logistic regression model. Almost 50% of participants were excluded by the most stringent inclusion criteria. Increased body fat percentage and proportion of time in moderate-to-vigorous activity were associated with decreased odds of meeting Criterions A and B. This research contributes to a growing understanding of the impact of differing accelerometer reduction approaches to sample retention and bias in adolescent physical activity research.

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We examine the impact of different accelerometer data inclusion criteria on participant retention.

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Fewer participants were included with more stringent accelerometer data inclusion criteria.

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Higher body fatness was associated with reduced odds of meeting more stringent criteria.

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Moderate-to-vigorous activity was associated with reduced odds of meeting more stringent criteria.

Cohort profile: Pacific Islands Families (PIF) growth study, Auckland, New Zealand

PURPOSE

This article profiles a birth cohort of Pacific children participating in an observational prospective study and describes the study protocol used at ages 14-15 years to investigate how food and activity patterns, metabolic risk and family and built environment are related to rates of physical growth of Pacific children.

PARTICIPANTS

From 2000 to 2015, the Pacific Islands Families Study has followed, from birth, the growth and development of over 1000 Pacific children born in Auckland, New Zealand. In 2014, 931 (66%) of the original cohort had field measures of body composition, blood pressure and glycated haemoglobin. A nested subsample (n=204) was drawn by randomly selecting 10 males and 10 females from each decile of body weight. These participants had measurement of body composition by dual-energy X-ray absorptiometry, food frequency, 6 min walk test and accelerometer-determined physical activity and sedentary behaviours, and blood biomarkers for metabolic disease such as diabetes. Built environment variables were generated from individual addresses.

FINDINGS TO DATE

Compared to the Centres for Disease Control and Prevention (CDC) reference population with mean SD scores (SDS) of 0, this cohort of 931 14-year-olds was taller, weighed more and had a higher body mass index (BMI) (mean SDS height >0.6, weight >1.6 and BMI >1.4). 7 of 10 youth were overweight or obese. The nested-sampling frame achieved an even distribution by body weight.

FUTURE PLANS

Cross-sectional relationships between body size, fatness and growth rate, food patterns, activity patterns, pubertal development, risks for diabetes and hypertension and the family and wider environment will be examined. In addition, analyses will investigate relationships with data collected earlier in the life course and measures of the cohort in the future. Understanding past and present influences on child growth and health will inform timely interventions to optimise future health and reduce inequalities for Pacific people.

Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012

BACKGROUND AND PURPOSE

There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA).

METHODS

The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded.

RESULTS

There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36-43), and attack rate was 63 (95% confidence interval, 59-68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure-lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation.

CONCLUSIONS

This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required.

Project Energize: intervention development and 10 years of progress in preventing childhood obesity

Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Waikato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The programme's unique community-based approach is inclusive of all children, serving a population that is 42% Māori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.

Pacific Islands Families Study: Signs of puberty are associated with physical growth at ages 9 and 11 years

AIM

To prospectively observe, at ages 9 and 11, the relationship of parental report of pubertal signs with height, weight, body mass index and birth weight in children of the Pacific Islands Families cohort born in the year 2000.

METHOD

At ages 9 and 11 years a parental questionnaire assessed five gender-specific pubertal signs for 619 children and height and weight were objectively measured. At 9 years, body fatness was derived from frequency bioimpedance analysis. Birth weight was obtained from hospital records. Anthropometric measures of children with and without pubertal signs at each age were compared.

RESULTS

At both 9 and 11 years, more than 80% of both boys' and girls' parents reported the presence of a growth spurt. The growth trajectory between 9 and 11 years was steep compared to the Centers for Disease Control reference child. At age 11, girls showing pubertal signs had substantially greater height, weight and body mass indexes than girls who did not. Girls with a growth spurt at age 9 years (91%) had a heavier birth weight than those without; a difference of 250 g (95% CI 50, 450 g).

CONCLUSION

The relationships between birth weight, rapid growth in childhood and early pubertal signs are complex. In addition to biological factors, food security and socioeconomic factors need to be addressed to ensure that the children of these children are exposed to an environment that is supportive of healthy rates of growth and development.

Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing: Randomized Controlled Trial

BACKGROUND AND PURPOSE

Stroke recurrence rates are high (20%-25%) and have not declined over past 3 decades. This study tested effectiveness of motivational interviewing (MI) for reducing stroke recurrence, measured by improving adherence to recommended medication and lifestyle changes compared with usual care.

METHODS

Single-blind, prospective phase III randomized controlled trial of 386 people with stroke assigned to either MI treatment (4 sessions at 28 days, 3, 6, and 9 months post stroke) or usual care; with outcomes assessed at 28 days, 3, 6, 9, and 12 months post stroke. Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months. Secondary outcomes included self-reported adherence, new stroke, or coronary heart disease events (both fatal and nonfatal); quality of life (Short Form-36); and mood (Hospital Anxiety and Depression Scale).

RESULTS

MI did not significantly change measures of blood pressure (mean difference in change, -0.2.35 [95% confidence interval, -6.16 to 1.47]) or cholesterol (mean difference in change, -0.0.12 [95% confidence interval, -0.30 to 0.06]). However, it had positive effects on self-reported medication adherence at 6 months (1.979; 95% confidence interval, 0.98-3.98; P=0.0557) and 9 months (4.295; 95% confidence interval, 1.56-11.84; P=0.0049) post stroke. Improvement across other measures was also observed, but the differences between MI and usual care groups were not statistically significant.

CONCLUSIONS

MI improved self-reported medication adherence. All other effects were nonsignificant, though in the direction of a treatment effect. Further study is required to determine whether MI leads to improvement in other important areas of functioning (eg, caregiver burden).

CLINICAL TRIAL REGISTRATION

URL: http://www.anzctr.org.au. Unique identifier: ACTRN-12610000715077.